Morgan & Mikhail Chap 2 (Operating Room Environment) Flashcards
Surgical Safety Checklist
Hospital Sources of Oxygen
E-Cylinders
Characteristics of Medical Gas Cylinders
Nitrous Oxide
Vacuum
Carbon Dioxide
Delivery of Medical Gas
Temperature
Humidity
In previous decades, the maintenance of adequate operating room humidity was
important because static discharges were a feared source of ignition when flammable anesthetic gases such as ether and cyclopropane were used. Now, humidity control is more relevant to infection control practices, and ambient operating room humidity should be maintained between 20% and 60%. Below this range, the dry air facilitates
airborne mobility of particulate matter, which can be a vector for infection. At high humidity, dampness can affect the integrity of barrier devices such as sterile cloth
drapes and pan liners
Ventilation
A high rate of operating room airflow decreases contamination of the surgical site.
These flow rates, usually achieved by blending up to 80% recirculated air with fresh air, are engineered in a manner to decrease turbulent flow and to be unidirectional.
Although recirculation conserves energy costs associated with heating and air conditioning, it is unsuitable for WAGD.
Therefore, a separate waste anesthetic gas scavenging system must always supplement operating room ventilation. The operating room should maintain a slightly positive pressure to drive away gases that escape
scavenging and should be designed so fresh air is introduced through, or near, the ceiling and air return is handled at, or near, floor level.
Ionizing Radiation
A basic principle of radiation safety is to keep exposure “as low as reasonably
practical” (ALARP). The principles of ALARP optimize protection from radiation
exposure by the use of time, distance, and shielding. The length of time of exposure is
usually not an issue for simple radiographs such as chest films but can be prolonged in fluoroscopic procedures, such as those commonly performed in interventional radiology
or pulmonary procedural areas, during c-arm use, and in a diagnostic gastroenterology
center. Exposure can be reduced to the provider by increasing the distance between the beam and the provider.
Protection from Electrical Shock
Surgical Diathermy
Because pacemaker and
electrocardiogram interference is possible, pulse or heart sounds should be closely monitored when any ESU is used. Automatic implanted cardioverter defibrillator devices may need to be suspended if monopolar ESU is used, and any implanted cardiac
device should be interrogated after use of a monopolar ESU to verify that its settings have not been altered by electrical interference.
Surgical Fires
Almost all surgical fires can be prevented
(Figure 2–11). Unlike medical complications, fires are a product of simple physical
and chemical properties. Occurrence is guaranteed given the association of fundamental
combustion factors, but it can be almost entirely eliminated by understanding and heeding the basic principles of fire risk. The most common risk factor for surgical fire
relates to the open delivery of oxygen.
Administration of oxygen in concentrations of greater than 30% should be guided by the clinical presentation of the patient and not by protocols or habits.
Increased flows of oxygen delivered via nasal cannula or face mask are potentially
dangerous. When enriched oxygen levels are needed, especially when the surgical site is above the level of the xiphoid, the airway should be secured by either an
endotracheal tube or a supraglottic airway device.
When the surgical site is in or near the airway and a flammable endotracheal tube is
present, the oxygen concentration should be reduced for a sufficient period of time
before the use of an ignition device (eg, laser or cautery) to allow adequate reduction of
oxygen concentration at the site. Laser airway surgery should incorporate either jet ventilation without an endotracheal tube or the appropriate protective endotracheal tube
specific for the wavelength of the laser. Precautions for laser cases are outlined below.
Should a fire occur in the operating room, it is important to determine whether the fire is located on the patient, in the airway, or elsewhere in the operating room. For fires occurring in the airway, the delivery of fresh gases to the patient must be stopped immediately.
Laser Safety
